It's more than just uncomfortable. Ill-fitting condoms can decrease their effectiveness in preventing unwanted pregnancies and the transmission of sexually transmissible infections.

When men say condoms don't fit, some might just be telling the truth. Health professionals are regularly confronted by men's complaints that condoms do not fit, or that they are uncomfortable. Correct condom use is critical for preventing unwanted pregnancies and the spread of sexually transmissible infections (STI), yet an Indiana University study found that study participants who reported problems with the fit and feel of condoms were also among those who reported the highest rates of condoms breaking and slipping. "Most recent research has focused on how people use condoms with little attention to the physical characteristics of condoms themselves," said Michael Reece, director of the Sexual Health Research Working Group and an associate professor in Indiana University Bloomington's Department of Applied Health Science. "Our recent research, however, indicates that sizes and shapes of the penis vary widely, but the range of condom sizes is rather limited; so it could very well be the case that there are aspects of the traditional condom that some men find too tight or too loose, influencing their ability or desire to use them during sexual encounters." Discussing penis size or condom issues with a healthcare practitioner can be challenging, so Reece and his colleagues have developed a questionnaire that can help physicians and those working in sexual health programs such as HIV clinics engage men in these conversations. They might be able to direct the men to condoms that better meet their specific needs. "Our 'Condom Fit and Feel Scale' offers a way for men to express in a confidential way to health care providers the exact concerns that they have with condoms related to length, width and tightness or looseness," said Debby Herbenick, associate director of SHRWG and research associate in the Department of Applied Health Science. Reece, Herbenick and Brian Dodge, associate director of SHRWG and research associate in the Department of Applied Health Science, describe the scale in a recently published article in the journal Sexually Transmitted Infections.

Background: Condoms remain one of the most effective means of preventing both unintended pregnancies and sexually transmissible infections (STI) such as chlamydia, gonorrhea and HIV. Ensuring that men and women use condoms consistently and correctly, however, is often a challenge.

One size doesn't fit all: In this study, a substantial number of men reported a variety of problems with the fit and feel of condoms. Specifically, 21 percent reported that condoms felt too tight; 18 percent reported that condoms felt too short; 10 percent reported that condoms felt too loose; and 7 percent reported that condoms felt too long.

From study to practice: Translating research into practice is a core mission of SHRWG. Reece said he and his colleagues would be glad to send the scale to healthcare practitioners -- particularly those working in HIV, STI and pregnancy prevention programs -- and to help them incorporate it into their practice. They also can direct agencies to resources that can help people find condoms in different sizes and shapes. Reece said their Condom Fit and Feel Scale also could be helpful to condom manufacturers, who continue to work to develop and market more comfortable condoms, which ultimately results in their more effective use.

"Experiences of condom fit and feel among African-American men who have sex with men," Sexually Transmitted Infections, 2007.

Sex after cancer. Significant sexual problems often are an unexpected -- and unwelcome -- side effect of the treatment of early-stage cervical and endometrial cancer for many women following hysterectomy. A targeted therapeutic approach involving mindfulness training has been found to improve desire, orgasm, arousal and other aspects of sexual satisfaction in just three one-hour sessions. "Often women who have had cancer are interested in being sexual, physical. A lot of these women can be in their 30s," said Julia Heiman, director of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. "By offering women something that can improve this part of their lives, in a sense you're investing in the hopeful side of their surviving a serious disease like cancer."

Background: Quality of life issues are becoming more important in cancer research as cancer survival rates increase and more people live for years with cancer as a chronic condition. Being close to someone can benefit survivors' overall wellness, just as the absence of a sexual relationship can hurt a relationship. Heiman said it is unusual, however, for post treatment cancer counseling to address sexuality because so many other important issues, such as nutrition and exercise, also need to be addressed. Heiman and Lori Brotto, professor in the Department of Obstetrics and Gynecology, University of British Columbia, in Vancouver, are co-authors of the study, "A Psychoeducational Intervention for Sexual Dysfunction in Women with Gynecologic Cancer," published online in the Archives of Sexual Behavior. Sexual problems are associated with treatment of early-stage cervical and endometrial cancer in more than half of the women who undergo hysterectomy even though no similar association exists when hysterectomy is performed to treat benign conditions, such as fibroids.

Psychoeducation includes "Mindfulness:" Mindfulness is an ancient Eastern philosophical and spiritual practice that involves focusing on the moment rather than being distracted by unrelated thoughts and worries. Little sexuality research has involved mindfulness techniques. In Heiman and Brotto's study, this practice is part of the psychoeducational approach to help women make emotional and conscious changes in their thoughts about illness and sexuality.

The study: Brotto and Heiman's study involved 19 women who had hysterectomies as part of their treatment for early stage cervical and endometrial cancer. Following the treatment, they experienced serious sexual problems, including lack of lubrication, less actual or perceived genital sensation during sex and in some cases a deterioration of their relationship. In three, one-hour sessions, the women were given information about sexual skills and relaxation techniques, training in mindfulness techniques and home-work assignments that asked them to practice their new skills. Heiman said the therapy was skills-oriented rather than based on discussing the women's difficulties. She said the therapy used in their pilot study could be offered by social workers and nurses, not just psychologists. "It can be someone who knows something about the conditions the women are experiencing," Heiman said, "someone aware of the fact that it's important and remarkable when people make an effort in this area."

In addition to the improvements in sexual satisfaction, the degree of mild depression significantly decreased among the study participants, who reported an improvement in their overall quality of life. The authors note there are few psychoeducational treatment options for women with sexual problems, especially treatments that also consider the psychological issues arising from a cancer diagnosis. The research was supported by the Social Science Research Council and the Ford Foundation.

To speak with Heiman or to receive a copy of the study contact Jennifer Bass at 812-855-7686 or jbass@indiana.edu. Top

Allison Chopra, a fitness expert at Indiana University, encourages her personal training clients to break their more ambiguous goals of say, feeling better or dropping a few dress sizes, into smaller goals that can be achieved in three to four weeks. She discourages weight-oriented goals because weight loss is a long-term process and everyone loses weight at different rates. Instead, she wants to know how her clients feel. "I ask them, are you feeling better? How's your confidence, your energy level? Are you feeling better about yourself?" said Chopra, the personal training coordinator for IU Bloomington's Division of Campus Recreational Sports. "But these are harder to track."

Chopra offers the following tips concerning goal-setting, encouraging people to be SMART about their goals. The industry catch-phrase SMART stands for Specific, Measurable, Attainable, Reward (as in, give yourself one when you've achieved a goal) and Time (set a time for reaching the goal):

Wellness goals should not be underestimated. People can feel a lot of satisfaction in meeting them, building momentum for other goals. "One goal I set for some of my clients is to get eight hours of sleep each night for a week," Chopra said.

Goals need to be attainable and realistic. Challenging yourself to eat no fat for a week could be setting yourself up for failure. Chopra encourages some of her clients to eat breakfast every morning, or at least do so for a week.

Be specific. A goal of "eating better," is an example of a worthwhile but ambiguous goal. A more effective or specific goal might be to limit sweets to one a day for the next week or to limit cookies to the weekend.

Exercising too much could be counter-productive. Adequate rest can result in better workouts, Chopra said. "I tell people, more than you'd think, not to exercise as much," Chopra said. "Our muscles need time to rest and repair themselves. For a normal exerciser, not an athlete, three to five days a week is good. When people start missing days, they can become disappointed and start missing more."

Keep track. Write down your goals and progress, noting it in a journal, notebook or other medium. Put goals in a visible spot. Fitness goals could include performing some form of physical activity for a certain number of days each week or a certain number of minutes. Energy (how do you feel?) can be measured on a scale of one to 10 each day. Pedometers can be used to count steps, increasing the number over time.

Chopra is a big fan of small steps and a forgiving temperament. If a goal is not met, she said, it should be reassessed to make sure it's reasonable and then sought after again -- after a brief break. "Getting fit or feeling well is a long process," she said. "It doesn't happen overnight."

Chopra can be reached at 812-855-4622 and allalsmi@indiana.edu. The Division of Campus Recreational Sports is part of the School of Health, Physical Education and Recreation. Top